Skyvision Scores Top Twin Bridges Score!

Drum roll, please! Dr. Darrell White and Skyvision centers of Weslake scored the highest score yet recorded on the Twin Bridges Scale of cataract surgery quality. The Twin Bridges Score evaluates 100 consecutive cataract surgeries in patients who don't have any other major eye problems. The two measurements are vision (20/40 or better at 1 week post-surgery) and accuracy (+/- 1.00 from the planned post-surgery prescription). The highest possible score is 100. The highest recorded score to date is 99, the same score that Dr. White and Skyvision achieved!

That's right...Dr. White and Skyvision equalled the scores of the best cataract surgeons in America!

We expanded our evaluation to look at ALL cataract surgeries, including those that were performed on patients who also had complex cataract surgery or suffered from other diseases like macular degeneration or glaucoma. Our score on all surgeries, even without screening out paitents who had other, vision-threatining diseases, was 97. STILL one of the highest ever recorded.

We will continue to measure our results using the Twin Bridges Score as well as any other validated quality measurements. Congratulations to Dr. White and the entire Skyvision Centers surgery team!

Rating Cataract Surgery: The Twin Bridges Score

We introduced something called the Twin Bridges Score, a measurement of the quality of cataract surgery proposed by a very influential consultant, John Pinto. Mr. Pinto has 2+ decades of experience working in eyecare with ophthalmologists, eye surgeons just like our Dr. Darrell White. Here's a LINK to an animated video on cataract surgery to help.

The Twin Bridges study group looked at many possible quality indicators for cataract surgery in the hope that there might be a way to identify the best cataract surgeons in America. The three that they settled on take into account safety, technical ability, and accuracy/service. The safety issue is very easy to understand: what is the complication rate for an individual surgeon? Interestingly, in the original group studied the rate of surgeon-dependent complications was so low that there was no way to add it to a score. In other words, in any measurement of the top group of cataract surgeons in the United States you can't tell any difference between them on the basis of safety--they all have complication rates that are very, very low.

How well the cataract surgery goes can be determined, at least in part, by how quickly someone recovers from surgery. How quickly you see well, up to a level of vision that would at least allow you to drive a car. In most states that means 20/40 vision, and a reasonable time to look at this is one week out from the surgery. If your vision is already good here it is likely that you had well-done surgery. In fact, in the Twin Bridges group most patients had much better vision at one week.

Lastly, the accuracy of the implant power chosen is a reflection on the care that the surgeon and his or her team take in the planning and execution of the surgery. The Twin Bridges score looks at how close each patient came to the planned outcome or expected glasses prescription after the surgery. This all adds up to a score with a maximum of 100, where above 90 is where the best of the best are.

Where is Skyvision and Dr. White? Tune in...

No Cataract Benefit From Vitamins C and E

The search continues for some kind of prevention for the development of cataracts. A cataract is a clouding of the crystalline lens that sits just in back of your pupil. The only way to "cure" a cataract is to remove it.

We see all kinds of things in newspapers and magazines about new treatments for cataracts, or more commonly, new ways to prevent cataract formation or growth. Some of them even have some theoretic backing to them. This was the case with vitamins, specifically vitamin C and vitamin E which are anti-oxidant vitamins. One of the most common theories about cataract formation is that it is due to oxigen radical formation with age.

The "Physicians' Health Study II" is a very long-term study that has looked at many aspects of doctors' health in Boston. This particular study evaluated the possible benefit of Vitamins C and E in the prevention of cataract formation. More than 14,000 doctors are enrolled in the study. NO BENEFIT was found as far as cataracts are concerned with taking extra  Vitamin C or E.

So, it's back to the drawing board for now. Check back here for the results of Skyvision and Dr. White with the Twin Bridges cataract quality study; we think you'll be impressed!

A Visit From Dr. Parent!

We had the privilege of hosting Dr. Rex Parent and some of his staff here in Westlake on Monday! Dr. Parent is a very famous cataract surgeon from Fort Wayne Indiana who met our Dr. White in Chicago at the big American Academy of Ophthalmology meeting this Fall. At dinne the two doctors had a chance to talk about some of their clinical interests and Dr. Parent was intrigued by our Skyvision Centers Dry Eye protocols enough to come for a personal visit.

One of the technicians from Indiana, April, is a long-time sufferer of Dry Eye, so we put her through our full work-up. At the end we confirmed her diagnosis and made some suggestions on how she could be more comfortable. We had a chance to explain and demonstrate how we think about and take care of Dry Eye Disease, not only with April but with several of our own Skyvision patients who were gracious enough to partake in the teaching.

We hope that the visit was helpful for Dr. Parent and his staff, but especially for his patients. Dr. Parent was very clear that he wants all of his patients to receive the very best care possible for EVERYTHING, especially Dry Eye. We are all very flattered by their visit.

And April, make sure to let us know how you are doing!!

Rating Cataract Surgeons: The Twin Bridges Score

How can you rate cataract surgeons? It's very difficult to create any kind of rating scale for any  kind of doctor at all, really. There's just so much that goes into the doctor/patient relationship; it's really hard to know what to look at and how to rate that.

Some types of medicine do have measurements that we can evaluate when we wish to find some way to rate quality. Many of the surgical specialties are able to look at how infrequently a particular surgeon has complications in his or her operations, for example. As eye surgery has advanced over the last 20 years or so, every operation that your eye surgeon performs is much safer now, with many fewer complications than even 5 or 10 years ago!

With cataract surgery we can look at a couple of very simple measurements to evaluate the quality of the surgery and the surgical experience. We're in the vision business, after all, so we can look at how well you see! If we look at the best vision possible at the one week mark after cataract surgery we can know something about how well t the surgery was done.

We also know something about eyeglass prescriptions ! At the one month visit after cataract surgery we can look at how close the final eyeglass prescription is to the surgical plan in order to determine if the best cataract implant power was chosen, and if that implant was inserted well.

These two measurements, vision with your best glasses one week after surgery and the amount of prescription in the glasses, are part of what makes up the "Twin Bridges Score", a way to rate cataract surgery and surgeons. Tune in this week as we explain a little more about this score, and to see how Dr. White stacks up in Cleveland and nationally!

Skyvision Customer Service

Do you know the Skyvision story? Skyvision Centers was founded by Dr. Darrell White, Dr. Scott Schlegel, and Dr. Gregory Kaye in Westlake, Ohio in January of 2005. The business was designed to be a customer service business with the sole product being eye care. It was essentially started from scratch with nothing but new ideas added to a committment to providing the very best level of eyecare imaginable!

Not a single other eyecare practice or medical practice was evaluated or benchmarked. The founders studied and benchmarked consumer service giants like Nordstrom's and the Ritz Carlton to see how they took care of their customers. We even spent some time looking at the practices of the Canyon Ranch Spa to see how they did things!

In order to show all of the staff members at Skyvision Centers what truly excellent customer care feels like, EVERYONE went on a customer service field trip. We had lunch at a Holiday Inn, and then had dinner at the Ritz Carlton. We shopped for cosmetics at Nordstrom's and then at Dillards. And finally, we experienced the check in process for at stay at both Holiday Inn and the Ritz. It's one thing to TALK about what customer care excellence is, but quite another thing when you EXPERIENCE the difference between good and great service.

We've done this a couple of times, and it's time to do it again! Stay tuned for updates and first-person accounts of what happens on our "Skyvision Centers Customer Service Field Trips" as we explore the best that Cleveland has to offer.

Tear Osmolarity Part IV: Prescription Medicines

Sometimes an over the counter (OTC) medicine just isn't enough. Even if your artificial tear was chosen based on advanced testing like the TEAR OSMOLARITY test from Tearlab, it's still possible that you will not have enough relief from your symptoms. This is the time for prescription medicines for your dry eye.

Let's use a couple of simple, straight-forward examples of how our Skyvision Centers doctors use tear osmolarity in the process of choosing a medical treatment for dry eye. If you have symptoms from your dry eye syndrome that are making you uncomfortable, and artificial tears are not enough, there are two very good prescription eye drops to help: RESTASIS and AZASITE*.

Classic dry eye involves a low production of your own, natural tears. This is most often accompanied by an increase in your tear osmolarity. If you have dry eye, a decreased amount of tears (with or without evaporation), and a tear osmolarity ABOVE 308, we have found that Restasis is the first medicine to prescribe.

When your tears don't work well enough you have early evaporation of the tears from the surface of your eye. We call this the "Dysfunctional Tear Syndrome". It can be caused by several things, but observations made by Dr. Darrell White has led us to the conclusion that evaporation along with a tear osmolarity UNDER 300 responds best to an initial treatment with Azasite*.

The really neat use of TEAR OSMOLARITY is when you have low tear volume AND fast evaporation! If the "saltiness" test is below 300 or above 308 we can choose the initial treatment with confidence.

This strategy was first proposed by Dr. White and will be the subject of several academic publications in the near future.



*The use of Azasite for dry eye is a permitted "off-label" application.

Tear Osmolarity Part III: What Tear to Choose

At Skyvision Centers in Westlake all of our doctors use the TEAR OSMOLARITY test from Tearlab to help make the choice of which artificial tear product to use in order to make you feel better. There are SO many different brands and types of tears on the shelves in Cleveland's pharmacies it can be overwhelming, so we give you the guidance you need!

An osmolarity result of less than 300 is considered normal at Skyvision, and a result over 308 is abnormal. Our doctors combine this result with their observation of your natural tears and the surface of your eye to make their suggestions. Artificial tears presently come in 3 general categories: surface stabilizers (for evaporative dry eye), hydrators or supplements (for low tear production), and what we call "utility infielders" or all-purpose (for mixed dry eye).

If you have a high tear osmolarity, a result over 308, we will generally prescribe a hydrator like THERA TEARS, or OPTIVE. If your osmolarity is less than 300, especially if your tear break-up time is short (lots of evaporation), we have confidence in SOOTHE XP, BLINK, and SYSTANE BALANCE. If you have some symptoms with a result between 300 and 308, or if your osmolarity is low but you don't have lots of evaporation, good all-purpose tears like REFRESH and SYSTANE ULTRA often do the trick!

Dry eye is more than just saying "use tears", and we are committed to helping you use the best choice FOR YOU!!

Tear Osmolarity Part II: Choosing the Right Artificial Tear

Have you ever looked at all of the choices of artificial tears and other eye wetting stuff in the pharmacies in Cleveland? Pretty confusing, isn't it?! What's the difference? IS there a difference? How do doctors know which one to suggest?

Not only can TEAR OSMOLARITY, the measurement of how "salty" your tears are, help in making the diagnosis of certain types of dry eye syndrome, but it can also help the eye doctor choose which type of tear is best for you and your particular symptoms. Not all artificial tears are the same, and certain general types will be more appropriate in certain situations.

One way to put dry eye into different categories is to separate LOW TEAR PRODUCTION from TEAR EVAPORATION. This can be done by simply looking at your tears and measuring things like the amount of tears you have, or how long your tears stay smooth on the front of the eye. But these two things have lots of overlap. For example, some times low tear production can cause tear evaporation!

Here's where the tear osmolarity test from TEARLAB comes in. Internal findings made by Dr. Darrell White have shown that your symptoms can be effectively treated if we choose the type of artificial tear based on your osmolarity results. In other words, if you have both a low tear level AND a fast tear evaporation, the primary cause is likely to be found in the osmolarity test! For example, if your osmolarity is HIGH, poor tear production is probably what came first.

Make sure to check back here for more information on what tear products we suggest you use based on your TEAR OSMOLARITY results!

Using Your Tear Osmolarity Result Part I: Diagnosis

We use a test called TEAR OSMOLARITY when we are evaluating the surface of your eyes. Perhaps you shared some symptoms with one of the Skyvision staff that brought up the possibility of dry eye. Maybe one of our doctors looked at the front of your eye and was suspicious about something he saw. Sometimes your symptoms and your exam just don't add up. In all of these cases measuring your tear osmolarity, how salty your tears are, can help us determine if dry eye is part of the problem.

We use a very sophisticated instrument manufactured by the Tearlab company to do this test. It's basically a lab on a microchip! A very, very tiny sample of your tears is placed on the chip and a reading happens almost immediately. Normal osmolarity or "saltiness", is a measurement under 300, and abnormal is something over 308 (between the two is not really diagnostic).

Of course, this test can't be used all alone. Dr. White, Dr. Kaye, and Dr. Schlegel will use the results along with the information they get from your history and from looking at your eyes to come to a conclusion. But if your osmolarity is above 308, the chances are good that you have some kind of dry eye!

The tear osmolarity test is fully FDA approved, and we are hopeful that it will be covered by most insurances in 2011.

Dry eye is one of the most common causes of eye problems, not only in Cleveland but all over the world. Our doctors at the main Skyvision Centers office in Westlake are on the leading edge of the technology involved in making this important diagnosis.

A New Contact Lens From Bausch & Lomb

Here in Cleveland Skyvision Centers is your place to look for the latest developments in all parts of eye care! We thought we'd share a news release we just got from the folks at B&L, courtesy of the good people at BMC and Eyewire.


Bausch + Lomb Launches PureVision2 with High Definition Optics


Bausch + Lomb announced the launch of PureVision2 with High Definition Optics contact lenses, the latest development in the company's portfolio of lenses. Designed to reduce glare and halos while delivering excellent vision, these new monthly contact lenses bring together several improvements to help overcome the challenges that contact lens wearers face, including spherical aberration, an optical effect that can result in blurred vision, glare and halos. The result is a lens that provides crisp, clear vision, optimal comfort and breathability.

“The initial response from eye care professionals to the PureVision 2 with High Definition Optics was overwhelmingly positive based on patient reports of great vision and comfort,” said Dr. Michael Pier, director of Professional Relations, Vision Care - North America, Bausch + Lomb.

PureVision 2 with High Definition Optics optimizes design to reduce spherical aberration across the entire power range. The lenses are packaged in a unique solution that delivers outstanding comfort upon insertion. Additionally, the new lenses provide high levels of oxygen transmissibility during wear to ensure a healthy environment for the eyes. One of the thinnest lenses available, PureVision 2 with High Definition Optics are also exceptionally easy to handle.

Fulfilling unmet patient needs

The Needs, Symptoms, Incidence, Global Eye Health Trends (NSIGHT) study of 3,800 vision-corrected patients across seven countries revealed that vision is the most important feature when choosing eye-related products. Of the contact lens wearers experiencing glares or halos, 90 percent reported that they are interested in a solution that reduces glare, while 89 percent are interested in a solution that reduces halos. Fewer than 10 percent of the respondents reported having a complete solution for these symptoms. The survey, commissioned by Bausch + Lomb, was conducted by independent market research firm, Market Probe: Europe.

“When designing PureVision 2 with High Definition Optics, we looked to the lifestyles that millions of patients are living today. These lifestyles include activities in which vision is critical, including nighttime driving, classroom learning, and athletics,” said Lisa VanDeMark, vice president of Brand Marketing, Vision Care - North America, Bausch + Lomb. “With nearly 25 million Americans reporting that they drive between midnight and 6:30 a.m., and college students spending 11-15 hours in the classroom per week, PureVision 2 with High Definition Optics provides a contact lens designed for crisp, clear vision, especially in low light.”


We'll be evaluating the new Bausch & Lomb contacts at Skyvision Centers in our Westlake office soon.

Bifocal Contact Lenses and RevitalVision!

A recent article in the optometric literature cautions against wearing bifocal, multi-focal contact lenses and driving at night. The article goes on to explain that the focusing mechanism of the bifocal contact lenses decreases the "contrast sensitivity" of the people who wear them, and suggests that they wear regular, distance-only lenses at night.

We understand the concerns of the authors, but at Skyvision we also understand that it is important to provide the best vision possible in the simplest way you can. Multiple contact lens prescriptions for day and night use? Sure...if you are having lots of problems. But there's a better way!

Contrast sensitivity is the part of vision that determines how sharp or crisp images are. Like everything else the first part of contrast sensitivity is focusing light, in this case with a bifocal contact lens. Part 2 is processing the image in the brain, and here's where RevitalVision comes in! The RevitalVision Low Myopia and Sport programs are designed to increase contrast sensitivity! In all of the studies to date people who do this computer-based vision training program get at least a DOUBLING of their contrast sensitivity!

People see images that are TWICE as sharp and crisp after doing RevitalVision.

All of the doctors at Skyvision Centers in Westlake are fans of bifocal and multi-focal contact lenses. Most people have not difficulty with night vision, but everyone who wears them will see even better with RevitalVision!

Using Tear Osmolarity for Diagnosis and Treatment

Dr. Darrell White has been researching the best way to care for patients in Cleveland with Dry Eye since the mid-1990's. He was one of the first doctors to prescribe Restasis for inflammatory Dry Eye when it was approved some 10 years ago. Recently he began using a new medicine, AzaSite, in the treatment of Evaporative Dry Eye caused by inflammation in the eyelid glands that produce the oil part of our tears. Here is Dr. White talking about a TOTALLY NEW WAY to use the TearLab tear osmolarity measurement to diagnose and treat dry eye:

"Now that we have two very different, very effective treaments for dry eye it's very important that we make an accurate diagnosis about the TYPE  of dry eye that is present. Are there TOO FEW tears, or are the tears NOT WORKING PROPERLY? Not only that, but we need to try our very best to find out WHY the eye is dry, why the tear production is low or the tears aren't doing their job.

Skyvision Centers was the first eyecare practice in Cleveland to use the TearLab Osmolarity instrument. Not only has it helped us make the diagnosis of Dry Eye in difficult, confusing settings, but we are now using it to choose the most appropriate starting treatment for Dry Eye. As far as we know we are the ONLY eye doctors who are using this instrument to make this choice.

In a nutshell here is what we do: if you have a high, abnormal tear osmolarity, a reading greater than 308, we view this as a sign that your PRIMARY abnormality is in the microscopic glands that produce the salt water, or AQUEOUS portion of your tears. Treatment is directed at these glands and often involves Restasis. If your osmolarity measurement is between 300-308 we do not feel that it adds to the decision on how to treat, and that decision is made solely on other signs we see on your exam.

If your tear osmolarity is below 300 and you have other signs of an EVAPORATIVE Dry Eye, especially if you have some signs of inflammation in your tear oil (meibomian) glands, treatment is directed at these glands and often includes AzaSite."

Dr. White, Dr. Schlegel, and Dr. Kaye will be publishing their protocol in both the ophthalmic and optometric journals, as well as sharing the results of their pilot study when they are available.

Thinking about Dry Eye

Did you know that Dry Eye is the most frequently searched eye care term on Google? Isn't that amazing? With all of the stuff that we read about in the news (like LASIK), and all of the more well-known medical problems (like Glaucoma), the thing that gets the most search requests is DRY EYE!

Why is that, do you think? Well, here at Skyvision we have a few thoughts on that. First, it's INCREDIBLY common. Lots and lots of folks have symptoms that are from dryness in their eyes. Things like burning, scratchiness, discharge (you know...eye "winkers"), and blurred vision that comes and goes can all be caused by dryness. Even tearing can be caused by dry eye, and dry eye may be the most common cause of tearing.

Another reason why Dry Eye is searched for so frequently is because it's hard to get answers about your symptoms. It takes a long time to tell all of your symptoms in the doctor's office, and then it can be really hard to make the diagnosis. We know, because in Cleveland the doctors at Skyvision Centers are often the 3rd, 4th, or even 5th stop for people suffering from Dry Eye!

Well, WE hear you! We've turned ourselves into Dry Eye EXPERTS! Stay tuned as we talk about some of the true Dry Eye breakthroughs at Skyvision.

Glaucoma 202 The Nerve Analysis

The very first thing that is lost when we have glaucoma damage is the individual nerve fibers that make up the optic nerve. Remember the optic nerve is the nerve that brings "light" from the eye to the brain. It's made up of tiny nerve fibers that are the innermost layer of the retina, the film that "sees".

We can actually measure how healthy these nerve fibers are using one of several Nerve Fiber Analyzers. At Skyvision Centers in Cleveland we are now using the OCT made by Zeiss, the most advanced instrument of its kind.

The OCT gives us a 3-dimensional view of the nerve fiber layer. Not only that, but it also compares the first test with a group of "normal" studies from age-matched studies. Follow-up tests can then be compared with one another to see if the glaucoma is getting worse.

Don't let glaucoma, the "silent thief"  steal your vision. Visit Dr. Kaye, Dr. Schlegel, and Dr. White at Skyvision Centers in Westlake for a complete evaluation, especially if there is glaucoma in your family.

Happy LASIK Anniversary, Dr. White!

It's been 11 years since Dr. White had LASIK surgery on his eyes! Happy Anniversary, Dr. White!

"LASIK is one of the nicest things I've ever done for myself," he says. "My friend Dr. Dave Hardten (who taught me how to do LASIK!) did my surgery 11 years ago. What a difference!"

Dr. White had worn Gas Permeable (hard) contact lenses for almost 30 years before his LASIK. "I broke 12 pairs of glasses in 12 months playing basketball in Jr. High and my Dad, who made glasses for a living, strongly 'suggested' I try contacts. They got me through all of my sports, including playing football in college."

Like many people who have had LASIK, Dr. White is now wearing reading glasses. He had his surgery at age 39 so he knew that his years of no glasses at all would be short. "I only need to wear my reading glasses in the morning and at night, so I'm STILL glasses-free in the office every day!"

Did you know that the VISX laser is the most widely used LASIK laser in the U.S.? Dr. White actually performed the very first VISX laser LASIK in Cleveland all the way back in 1994!!. Come visit us in Westlake and see if you are a candidate for LASIK. Talk to the doc who has been using the VISX laser longer than anyone else in Cleveland and ask him how HIS eyes are doing!!

An Upturn in Cleveland? Thoughts From Dr. White

Hi! Dr. White here. I thought I'd share some thoughts about our economy here in Cleveland and see if you have any thoughts of your own.

It's pretty clear that our local economy in the Greater Cleveland area failed to recover as completely as the rest of the country after the tragedy of 9/11. Even so, we DID grow between 2003 and 2008, and we were perking along rather nicely, I think. New businesses, some growth in our traditional businesses, and some energy and excitement in Cleveland itself.

Then along came August of 2008 and the collapse of the housing and banking markets nationally, and WHAM! We got socked. It sure felt like we got hit harder and went down further than lots of other places, and that's pretty much what we heard from all of you when you came in for your eye care here in Westlake at Skyvsion Centers.

We're noticing a little change in the conversations, though. Some of our patients who own or run businesses are starting to see juuuuust a little uptick. Some are even hiring folks. My wife and I couldn't make it to the grocery store last week so we ended up going out to dinner on Wednesday and Thursday (we're brand new empty nesters!), and the restaurants were crowded! Mid-week, on the West Side! The wait was so long at the first restaurant on Thursday we actually had to leave an go to another.

These are tiny, little signs for sure. What are YOU seeing? Has our local economy stopped falling, and maybe even started to pick up, even just a little bit?

Let us know. We are all proud to be here for you, Cleveland, and proud to be here IN Cleveland.

Dr. White

Patient-Centered Medicine

At Skyvision Centers we make every effort to make your experience in our office as pleasant as we possibly can. We have made special efforts to build, decorate, and outfit our main office in Westlake in a way that will make your visit comfortable. Even little things like the type of coffee service we have are the result of many hours of research and study. Did you know that our coffee machines are choices made after 40 hours of research and testing?!

We had a very strange experience at Skyvision yesterday afternoon. One of our new patients complimented us and thanked us for running "on time" and not wasting her day. Great, right? Well, actually every single staff member including the doctors, knew that we were actually 23 minutes behind schedule when we saw that lovely woman, and every single staff member felt bad about that.

We know what you are thinking right now. You're thinking wait a minute...23 minutes? Exactly 23 minutes? Not only did everyone know that they were running behind, but everyone knew it was 23 minutes? And everyone cared?! How does THAT happen?

We "time stamp" everything that occurs in our office so that we are aware of how long your visit is taking. We look at our overall results, too. We recently hired an additional technician and opened a new examination room when we found that our patients were starting to spend a little longer in the office. And now we are back to being "on time"! We know that your time is very valuable and we are fanatics about trying not to waste even a minute.

Skyvision Centers is a true "Patient-Centered" medical practice. We try, REALLY try to give you the best possible medical outcome at the same time that you have the best possible experience in our office, and we are constantly measuring to see that we do!

Bifocal Contact Lenses + RevitalVision!

Wouldn't it be cool to be able to continue to wear your contact lenses, and ONLY your contact lenses even when you get to the age when most people are wearing cheaters over their contacts? You're driving around Cleveland, maybe having lunch at Crocker Park, and you drive AND read the menu with only your contacts? We thought you'd like that idea!

Bifocal contact lenes have come a long way  in the last couple of years. For some people a "straight out of the box" fitting is all that is necessary. However, many folks find that their vision with bifocal contact lenses is just not as sharp as it is with their bifocal glasses, or even as sharp as distance contacts and cheaters. But that means wearing glasses! What to do?

Do you remember our posts about RevitalVision? RevitalVision is the computer training program that increases our ability to process the images that our eyes focus and send to the brain. Think of RevitalVision as opening up extra lanes on the "vision highway", like taking a one lane road, increasing the speed limit, and then opening up two extra lanes! RevitalVision dramatically increases our contrast sensitivity, our ability to see sharply and crisply, and this makes it easier for us to use bifocal contacts!

This is another innovation we are working on at Skyvision Centers in Westlake. Come see us if you are a contact lens wearer who might need readers and see if you can benefit from our bifocal/RevitalVision combo!

Is It Time For You To Have LASIK?!

Did you know that more than 500,000 U.S. servicemen and women have had Laser Vision Correction? Much of the original work was done by Dr. Steven Schallhorn, a former Navy Top Gun pilot (who still holds a record at Top Gun set in the 1980's!). Dr. Schallhorn pioneered the use of Laser Vision Correction, especially LASIK, in the Navy.  Now our military pilots, soldiers, sailors...even Navy SEALs are getting LASIK  and getting fantastic results.

LASIK  and PRK, the two types of Laser Refractive Surgery, are safe and effective means to become less dependent on glasses or contact lenses. Many millions of Americans, and millions more around the world, have had LASIK done and are now glasses free! In fact, in the USAEyes Core Survey being done as part of a review of LASIK for the FDA, 98% of patients were happy with their vision and their quality of life. 98% would recommend LASIK to friends and family!

Do you wear contact lenses or glasses? Do you live in the Cleveland area? Is it time for YOU to have LASIK? Call us at Skyvision Centers in Westlake for a consultation with Dr. Darrell White our LASIK surgeon!

Azasite for Blepharitis

Blepharitis is an inflammatory disease of the eyelid margins. It is usually caused by either an over-grwoth of the naturally occurring bacteria that live on our eyelids, or from an inflammation that comes from within our bodies. Azasite is a very effective antibiotic gel drop that works very well to counteract the symptoms of Bleparitis. Here's a report on a study done on Azasite:

"Study Shows Azasite Improves Symptoms of Blepharitis



Azithromycin ophthalmic solution 1% (Azasite; Inspire Pharmaceuticals, Inc.)
provided significant improvement in signs and symptoms of blepharitis after 4
weeks of treatment compared with baseline, and persisted in a 4-week follow-up
period, according to a study in Cornea.^1


Twenty-six patients (mean age, 64.2 years) with moderate-to-severe blepharitis
received azithromycin ophthalmic solution 1% in the absence of warm compresses
or eyelid scrubs for 28 days (twice daily on days 1 and 2 and q.i.d. on days
3-28). Blepharitis signs and symptoms were evaluated at baseline (day 1), and
compared with the end of treatment (day 29), and two follow-up visits (2 and 4
weeks post-treatment). Tear collection and eyelid margin bacterial cultures
were performed at baseline and end of treatment. Tear cytokines were measured
by a multiplex immunobead assay.


Four-week azithromycin treatment demonstrated significant decreases from
baseline in investigator-rated signs of meibomian gland plugging, eyelid margin
redness, palpebral conjunctival redness, and ocular discharge (P ? .002) at day
29, which persisted 4 weeks post-treatment (P ? .006). Patient-reported
symptoms of eyelid itching, foreign-body sensation/sandiness/grittiness, ocular
dryness, ocular burning/pain, and swollen/heavy eyelids also demonstrated
significant improvement from baseline (P < 0.001 for all symptoms and time
points, except P = .037 for ocular dryness at visit four), according to the
study. Eyelid margin culture exhibited significant decreases in
coagulase-negative staphylococci and Corynebacterium xerosis bacteria. Changes
in tear cytokine concentrations were not observed. Twelve patients experienced
19 adverse events, 15 of which were ocular, and none of which were serious.

1. Haque R, Torkildsen G, Brubaker K, et. al. Multicenter open-label study
evaluating the efficacy of azithromycin ophthalmic solution 1% on the signs and
symptoms of subjects with blepharitis [published online ahead of print].
Cornea. doi: 10.1097/ICO.0b013e3181ca38a0."


The doctors at Skyvision Centers in Westlake were the first in Cleveland to utilize this breakthrough treatment for the symptoms of Blepharitis!

Treating Astigmatism with Laser Vision Correction!

We've spent a little time talking about Astigmatism, what it is, and some of the ways we can treat it. Did you see Dr. White's video on our Youtube channel, Skyvision105? Here's a LINK to his latest "At the Dr. Whiteboard", Astigmatism 101. Be sure to check back, too--we hear there are a few bloopers that are real doozies!

If you are young, too young to have a cataract for example, the most successful way to SURGICALLY correct astigmatism is with Laser Vision Correction or LVC. There are two main types of LVC, LASIK and PRK. There's lots to learn about both of them, and we'll give you a ton of information about LASIK and PRK for all kinds of vision problems. As an introduction to LVC click on this Eyemaginations LINK for animated videos that describe  how they work.

When you have astigmatism in your prescription we can correct it, and remove your blurry vision, by putting the prescription right on the surface of your eye. We put the correction on your corneal, the window to the eye. This is a permanent correction and can be done for many types of astigmatism. You can actually choose NOT TO WEAR GLASSES after LASIK for astigmatism!

Call Skyvision Centers in Westlake, Cleveland's first truly patient-centered eyecare practice, and ask how our surgeon Dr. Darrell White can treat your astigmatism with LASIK or other LVC!

How Salty Are Your Tears? Why Does That Matter?

TEAR OSMOLARITY, the measurement of the saltiness or salinity of your tears, is an important measurement of the health of your tears and your eye lubrication. As you know, tears are a complex combination of salt water, mucin, and special oil called mebum. All three of these elements or ingredients are mixed up, kind of like Italian salad dressing, and they form the tears that coat the surface of our eyes every minute of every day. As an aside, the tears that we make when we cry, or when something gets in our eyes, are almost completely salt water.

The measurement of your tear osmolarity is a rather new test. It's fully FDA approved. When your tear saltiness is high this is an indication that your tears are not normal. Now, you may not have any symptoms when this is the case, but we usually only do the Tear Osmolarity test when you tell us that your eyes are not comfortable! At Skyvision Centers we use the most modern instrument made by the TearLab corporation to do your test.

Why is this an important measurement? Well, the two most important causes of a Dry Eye, or dry eye symptoms are problems in the production of either the salt water part of your tears, or in the production of the oil or lipid part of your tears. If you have a HIGH Tear Osmolarity it is most likely that your problem stems from something wrong with the production of the salt water in your tears. Either you are not making enough, or what you are making is not working well enough. A LOW Tear Osmolarity does not mean that you don't have Dry Eye Syndrome, it simply means that some other factor is the underlying cause.

The best research available right now shows that a Tear Osmolarity of under 300 is probably normal, or at least "normal enough"! Anything over 308 is abnormal. Measurements between 300 and 308 have to have some additional information from your exam to be meaningful. We will always tell you your number!

As far as we know Skyvision Centers was the first eye center in Northeast Ohio to use Tear Osmolarity in the care of Dry Eye.

Macular Degeneration is Coming to the Boomers

Here they come! The Baby Boom Generation is entering the 65+ age group. It's likely that everything we have seen happen to their parents and grandparents will also happen to the Baby Boomers.

A recent study was published looking at the incidence (how frequent) of Macular Degeneration in a group of people who have been followed for generations. 9.8%, almost 10 PERCENT of individuals in the Beaver Dam Offspring study who were over 65 years of age had some form of macular degeneration.

So, what does that mean for the Baby Boom Generation. Well, unless there is a breakthrough in preventative medicine roughly 10% of the 65 million Boomers will get some form of macular degeneration by the time they are over 65. 6.5 million cases of macular degeneration will need treatment.

It turns out that early detection and careful follow-up are very important when it comes to saving vision when macular degeneration is the problem. The biggest risk factors are 1) Family History 2) Gender: woman get it more than men 3) Eye color: it's more common in people with light colored eyes, and 4) Smoking. In other words, the only risk factor you can make a big difference in is smoking. That's a pretty good reason to quit!

Everyone over the age of 60 should probably have an annual exam, but if you have a family history or macular degeneration why not make an appointment at Skvysion and get checked out!

Attack of the Killer Ragweed!

You can't say we didn't warn you! It's BAAAACCCKKKK!! Ragweed season is here and it's here in a big way. We've had all kinds of folks in the office already with red, itchy eyes to go with their sneezing and wheezing and runny noses.

So what to do? The best thing, of course, is to call Skvysion Centers and come in for a visit. All three of our doctors, Dr. Darrell White, Dr. Scott Schlegel, and Dr. Greg Kaye are experts in the treament of eye allergies, especially environmental allergies like Ragweed. A visit can help us determine if you need a prescription anti-histamine eye drop, a stronger steroid drop, or if you can get by with just an Over-the-Counter drop.

The two prescription drops that work the best in our opinion are ELESTAT and PAT-A-DAY, both advanced generation, multi-action anti-histamine drops. Many people find that the OTC drop ALOWAY very effective in treating itching as a symptom, even though it doesn't necessarily affect the underlying cause of the itch. We like them all!

Got red, itchy, teary eyes? Call us for an appointment!

What Is An Implant?

We're thinking a lot about cataract surgery at Skyvision Centers recently. Cataract surgery is a very gentle experience. We do it as an outpatient procedure--you come in, get it done, and go home on the same day! You're awake for the surgery. We do it under local anesthesia because it's safer for you and better for our surgeon, Dr. White. Our anesthesia assistants will give you something through your veins to relax you, and the special drops we use numb up your eye.

The surgery itself typically takes less than 10 minutes if Dr. White is the surgeon! We remove the cataract, replace it with a clear plastic implant, and then you go home.

Wait...IMPLANT? What's an implant? Well, glad you asked! An implant is a tiny lens called an "Intraocular Lens" or IOL that is place inside the eye, usually behind your pupil, and it take the place of the cataract lens that was removed. When we discuss your cataract surgery in the office a part of the discussion is about the lens implant or IOL you will receive as part of the cataract surgery experience. Here's an Eyemaginations LINK about cataract surgery and implants.

The two basic types of cataract implants or IOL's are "Traditional" and "Lifestyle". Let's talk about Traditional implants today. A traditional implant is like the top part of your glasses, it will focus at a single distance and it will take care of much of your nearsightedness or farsightedness. Since the IOL is clear it will dramatically improve your vision, and wait until you see how bright and vibrant colors will be! Most people will wear glasses after cataract surgery using a Traditional IOL, especially for reading but also often for things like driving as well.

Cataract surgery is one of the most important and exciting medical developments EVER! If your vision is blurry from cataracts be sure to talk to us at Skyvision Centers where we use the most advanced IOL's available!

When Should I Have My Cataract Removed?

Dr. White has been know to say that everyone who lives long enough will get a cataract. Indeed, everyone who lives long enough will need cataract surgery, and the only shame of NOT having cataract surgery is that you didn't LIVE long enough! If that's the case, when is the right time to have a cataract removed?

Cataract surgery has changed dramatically over the last several decades. The very idea of when to have your cataract removed is now radically different. Remember hearing from your parents or your grandparents that someone had to wait until their cataract was "ripe" enough? In the past cataract surgery was so dicey that doctors made people wait until they were essentially blind befor agreeing to do surgery. That's not the case today.

Cataracts cause your vision to change, to become more blurry, darker, or fuzzier. Sometimes your glasses prescription starts to change frequently. You might even find yourself taking your glasses OFF to read, sometimes called "second sight". Colors may start to look strange or different. When these vision changes start to affect your daily life it's time to start to think about cataract surgery.

Different people have different problems from their cataracts. Some folks find it harder to drive, especially at night. Reading can become more difficult, and the smaller or lighter the printing the harder it gets! We often hear that our patients use the small print at the bottom of the TV screen, or the box scores on baseball or football telecasts. The most important symptom or problem is the one that's most important to YOU!

If you are older than 55 and your vision is getting blurry, or someone has told you that you might have a cataract, come on in to Skyvision Centers and let us take a look! 

What is a Cataract?

We do lots and lots of cataract surgery at Skyvision Centers. In fact, Dr. White is one of the most famous cataract surgeons in Cleveland. But just what is a cataract, anyway? What does it do to your vision?

A cataract is a clouding of the natural lens that sits in back of our pupil, inside the eye. Although some folks get cataracts from medicines or other diseases, cataract growth is usually an aging change that occurs over time. Dr. White like to say that EVERYONE who lives long enough will get a cataract; the shame of NOT getting a cataract is that you didn't live long enough!

A cataract gradually causes your vision to become blurry. It usually happens pretty slowly, sneaking up on you. There are no medical treatments for a cataract. Once your cataract starts to cause enough trouble that glasses won't fix the only solution is surgery. Take a look at this Eyemaginations LINK for a couple of videos on cataracts and cataract surgery. We'll bring you lots of information on your cataract surgery options right here!

Don't forget to visit our website for more information on cataracts.

Here Comes the Ragweed!

Oh oh! You heard that right...HERE COMES THE RAGWEED!! It's almost that time of year again, that time when the ragweed pollen gets released here in Cleveland and all of our allergies explode. Runny noses, itchy noses, red and itchy eyes, they're all right around the corner.

Here's how it works: the pollen is something called an ANTIGEN, a substance that turns our immune system to the "on" position. The pollen activates cells in our body that have histamine in them, and this activation causes those cells to release the histamine into our blood stream. It's the histamine that causes all of our symptoms.

So what do we do? Well, as far as your eyes are concerned we have two really good prescription eye drops that work very well. PAT-A-DAY is a one time per day eyedrop that works very well, especially if you don't have any dry eye problems. The other option is ELESTAT, a two time a day drop that works well even if you do have dry eye. We like both of them at Skyvision.

So if you have annual allergies from ragweed now is the time to come in for a visit. Don't let that pollen getcha this year!

I Have Flashing Lights, and Now a BIG Floater

We hear this kind of story several times every day at Skyvsion. Bright flashing lights somewhere in the side of your vision that last for minutes to hours...sometimes like lightening bolts and sometimes just like a shower of stars. I time a great big floaty thing appears. It can be any shape but it often seems like a spider web that drifts in and out of view. You've had a posterior vitreal detachment!

A what?! What kind of detachment?

Remember the blog post about floaters? The vitreous jelly shrinks as we get older, and sometimes it actually shrinks to the point that it separates from the back of the eye. The back of the jelly, the part that was attached to the back of the eye, is now free floating, and it becomes dense and thick. Your big floater!

When the vitreous jelly pulls off it tugs on the retina putting traction or pull on the inner retina (the film on the inside of your eye). Now, the retina can only respond to ANY kind of stimulation in just one way. Bite it, scrratch it, tickle it, pull on it, or shine light on it, the retina will give off a sensation as if it has seen light. So when the vitreous jelly contracts and pulls off you get flashing lights!

The danger of a vitreal detatchment isn't so much the flashes or even the big floater; all of that will seem like it goes away in time. The REAL danger is that when it comes off it can take a piece of the retina with it causing a hole or a tear, and that can lead to a retinal detachment. Go HERE to see an eyemaginations video on vitreous detachments, and we'll talk some about retinal detachments another time.

When Should I Use My Tear Drops?

There are many degrees of Dry Eye so there are many answers to this question! For some people it's perfectly OK to just use an artificial tear when there is a little bit of discomfort. Feel a little dry? A tiny bit of scratchiness? Go ahead and put a drop in.

Other people have Dry Eye symptoms all the time. The doctors at Skyvision like to tell these folks that they should use their tears just like they were a prescription medicine. 2, 3, sometimes 4-6 times a day on a schedule is sometimes what it takes to be comfortable with your Dry Eye.

It turns out that it is usually easier to prevent the Dry Eye symptoms from starting than it is to stop them once they start! In other words, the time to take your eye drops is when you DON'T have any symptoms. If you wait until your eyes feel badly it's already too late.

Think of an image of a well with a bucket that hangs down into the water. If the well slowly drains all day long pretty soon the rope won't be long enough to reach the water. In order for the bucket to get to the water you first have to FILL UP THE WELL! Same thing with dry eye; if you don't keep the well full all day you won't get the benefit of the tears until you fill the well (your eye) back up!

Ask Dr. White, Dr. Schlegel, or Dr. Kaye what kind of artificial tear is best for you, and how much to use them.

I Have Floaters!

They're kinda like little bugs flying around, except there are no bugs there! Lots and lots of little spots in front of your eyes all of a sudden, and it seems like they are always RIGHT in front of your vision when you are trying to read. Or it feels like there's a spot just outside your field of view--is that the bug? You just can't shoo it away.

They're floaters!

Wait...what the heck's a floater, anyway? Well, a floater is a little speck of protein debris in the vitreous jelly, the jell that fills up the middle of the eye. The vitreous jelly (you may have heard it called vitreous humor in school) is very important for the development of the eye until we're about 2 years old. After that point it's really just there to cause mischief. One of the mischievious things it does is shrink.

The thing that make the vitrious a gel is the same thing that makes Jello a gel. There's a microscopic protein skeleton and as we get older that skeleton collapses upon itself. Little areas that used to be just barely microscopic are now just dense enough to be macroscopic. They form a little clump and VOILA...a floater.

So you've got floaters, what do you do about them? In time your brain will learn to ignore them. They become like background visual noise and your brain just ignores them, just like the old fashion elevator operator who didn't hear the elevator music any more because it was always there!

For some more information check out this Eyemaginations video here. If you DO have floaters make sure to get them evaluated at Skyvsion Centers.

Exciting Developments in Macular Degeneration Treatment

Macular Degeneration is the leading cause of blindness in older Americans. It come in two general varieties: wet (exudative) and dry (non-exudative). The defining difference between the two types is the presence or absence of bleeding and leaking from abnormal blood vessels.

Wet macular degeneration is potentially devastating, with rapid visual loss that can occur very suddenly. Several effective treatments have developed over the last 15 or 20 years, from laser photocoagulation to the injection of substances that cause the leaking and bleeding blood vessels to shrivel up and close. Wet macular degeneration is no longer a sentence to a lifetime of blindness.

On the other hand, up until very recently there hasn't really been any treatment for dry Macular Degeneration other than taking high doses of the anti-oxidant vitamens A, C, E, zinc, and copper. Formulations like Ocuvit PreserVision have been shown to slow the progression of dry AMD. There are now two exciting medicines in the FDA pipeline to treat dry AMD, one oral medication and one that is an eyedrop.

The oral medication is called Fenritinide and it is made by Sirion Therapeutics. This medicine has been shown in phase I and II studies to decrease the rate of worsening of dry AMD by up to 50%. The only side effect thus far is a decrease in night vision in some of the study patients. The results have been so positive that Fenritinide has been "fast-tracked" to phase III by the FDA.

The second exciting development is OT-551, an eyedrop made by Othera Pharmaceuticals. This medicine is in phase II after showing a positive effect with little to now side effects. We are very hopeful that it, too, will emerge from phase II with a "fast-track" designation so that  we will potentially have TWO options to treat dry AMD.

More on Sunglasses--Visible Light Transmission

It's a beautiful, bright sunny day in Cleveland, Ohio! We don't get too many of these for most of the year, but Spring and Summer around here can be magnificent. Let's talk about another thing that you should think about when you are choosing what sunglasses to wear, how dark should your sunglasses be.

The technical term for this choice is "Visible Light Transmission". When Eye Doctors and Opticians think about sunglasses we think about how much light actually gets through, the VLT. It's funny because when we talk about UV protection we talk about how much UV light DOESN'T get through. With VLT the darker the lens the lower the VLT in general. But sunglass lens technology has become so advanced that some relatively light lenses actually block out lots of visible light!

Your activity and your environment will help you choose your sunwear. Let's think about Cleveland for a minute. Right now it's pretty sunny. We're a lake community with Lake Erie just to the north of everyone and everything. Lake activities make you want POLARIZED sunglasses, and today you would look for something that has around 20% VLT. Two super examples would be the Nike Brown (16% VLT) or Grey (17% VLT) Max Tint Polarized lenses.


Now, it IS Cleveland, and we get lots and lots of cloudy, overcast days around here. On days like that it's not so important that you wear polarized sunglasses, but you could if you wanted. On cloudy days you want UV protection, decreased transmission of blue light waves, and a slightly higher VLT, usually around 40%. Good choices from Nike would be the Max Tint Orange (60% VLT) or Smoke (50% VLT). We often see Dr. White with his Max Tint Orange Nikes on cloudy days.

Why a Bowtie?

We recently asked Dr. White why he wears a bowtie. Here’s what he said (after he stopped laughing!):

“Why a bowtie? Wow...it’s been so long I haven’t given all that much thought to that. When I was in medical school my wife and I cleaned out the bargain tie bin at a local department store that was going out of business. Silk ties for 2 and 3 bucks! When we got home we noticed two bowties in the mix. I happened to be on call the next night so Beth tied one for me to wear—bowties stay out of the way of all kinds of icky stuff you encounter in a hospital.

Well, as luck would have it, the most popular show on TV was “Hill Street Blues”, and one of the detectives wore a bowtie. Whenever Henry Goldblum got stressed his bowtie came undone. Of course, my wiseguy fellow med students thought it would be fun to untie MINE...and I didn’t know how to tie it yet! Sooo, three hours in front of a mirror later and I was an expert on bowtie tying.

I must have gotten good feedback about the bowtie as a resident because I found myself wearing it more and more. Not everyone at NYU knew Dr. White the ophthalmology resident, but everyone knew Dr. Bowtie the eye doctor! Now if I go someplace without a bowtie I’m almost invisible.”

So there you have it, why Dr. White wears a bowtie. If you’re interested Dr. White gets his bowties from Beau Ties Ltd. in Vermont, and leeallison.com in Chicago. 

It's Sunglass Season!

Hey! Even in Cleveland  the sun comes out. It's springtime… almost summer, and it's time to think about sunglasses. At Skyvision we have everything to meet your sunglasses needs. We have high fashion names like Fendi and Coach, and we have some of the most high-tech offerings from companies like Oakley, Maui Jim, and Nike.

So why would you want to wear sunglasses? Well, there are two very important reasons to think about wearing sunglasses, even when it's not terribly sunny out. The first, and most important reason, is to protect your eyes from ultraviolet light. UV light is actually toxic to many of the structures in the eye including the lens and the retina. There is some very good research that shows that prolonged exposure to UV light causes cataracts, and in people with light colored eyes there seems to be an association between ultraviolet light exposure and macular degeneration.

Why else might you wear sunglasses? Lens technology has advanced so far in sunglasses that it's actually possible to ENHANCE your vision for a particular activity by wearing the appropriate type of sunglasses. For instance, the Nike Speed lens is dynamite for baseball. Nike also makes the very best lens for golf with lenses that enhance your ability to see contour and multiple shades of green on the golf course.

And who hasn't seen a photo of Lance Armstrong in his Oakley Jawbones careening around the corner in the Tour de France?! Oakley has pioneered the technology of “swappable” lenses, and the Jawbone is a great example of how one frame can accommodate many different activities simply by swapping out the lenses.

Skyvision centers is your headquarters for all of your sunglasses needs!

Over 40 Eyes...Why Can't I Read?

We know what you're thinking...who shrunk my arms? It's happening a lot around the office at Skyvision Centers, too. We're all getting a little older  around here and it seems like there are a bunch of reading glasses lying around everywhere now. As a matter of fact, the only person in the office who can't seem to find Dr. White's readers is DR. WHITE!

Why do we start to have trouble reading when we get older? To answer that we have to go all the way back to age 2 or so. Almost all of us is born a little farsighted or hyperopic. We focus our eyes to overcome this little bit of farsightedness using the same muscles that we use to focus on objects up close. This muscular process is called ACCOMMODATION. When we look at things up close three things happen: our eyes come closer together, our pupils get smaller, and the lens inside our eyes gets fatter. We have massive powers of accommodation at age two and then we gradually lose those powers as wel get older.

The medical term for "Over 40 Eyes" is PRESBYOPIA. When we lose enough of our power of accommodation that we can no longer see things up close we become presbyopic. Of course your kids will just say you got old! Here's a LINK to the Eyemaginations video on presbyopia.

So what can we do? Well, there are a bunch of options, actually. If your eyes are health you can just buy reading glasses at the pharmacy. You might have a different prescription in each of your eyes, and if so your Skyvision Centers eye doctor can prescribe a pair of reading glasses that are specific to you. Many of us need to wear glasses to see things far away--a pair of bifocals takes care of the up-close problem. Bifocal contact lenses are available, and you can even correct your vision with something called MONOVISION, with one eye corrected for near and one eye corrected for far vision.

Whew! That's a lot of options! Don't worry...we'll have lots of answers for you in future posts, and of course, we bet we'll see an "At the Dr. Whiteboard" video or two on this subject, too!

Let's Talk About Tears!

Before we get to the topic of how to treat Dry Eye let's take a couple of minutes to learn about tears. We have two kinds of tears lubricating the front of our eyes. We have our reflex, or emotional tears. These tears are created by the lacrimal gland that sits up and above our eyes. The lacrimal gland  makes the tears that we cry when we watch a sad movie, or if something gets in our eye.

It's the tears that lubricate our eyes from minute to minute that we are more interested in when we are talking about dry eye. These tears are made by different types of microscopic glands on the surface of our eyes, as well as deep within our eyelids. These tiny glands can be affected by all kinds of medical problems like arthritis, lupus, and the hormonal changes that come with getting older.

Normal tears consist of three different, separate substances. We  have mucin which is created by the goblet cells on the front surface of our eyes. We also have a salt water or aqueous component created by the glands of moll and zeiss. Lastly, we have an oily substance called meibum which is created by the tiny glands that sit just inside our eyelashes on the upper and lower eyelids. These three substances are mixed together, kind of like Italian salad dressing, to form a lubricating layer between our eye and the air.

Shake up a bottle of salad dressing and let it sit for a minute or two. Notice how there is a little bit more oil on the top surface, a thicker middle layer that is a mixture of everything in the salad dressing, and then a layer on the bottom that is really thick. This is a good way to visualize our tears. We have more mucin close to the eye, a mixture or emulsion of mucin and aqueous in the thicker middle, and then a layer which is mostly oil sitting on the surface and preventing evaporation of our tears.

When our tears are healthy we have just the right amount, and we have just the right proportion of the three different components. We start to have problems with dry eye when we either have too few tears, or when the three components do not mix well. Next, we'll talk about the different types of dry. See you soon!

How We Diagnose Dry Eye

So you've come to Skyvision Centers with red, burning or tearing eyes. Your vision gets blurry when you look at a computer. You always feels like there's something in your eyes. How do we know it's from Dry Eye? How do we make the diagnosis?

Well, the very first thing we do is LISTEN to you! We try very hard to hear what it is that's bothering you. After that there are several tests that the technicians and doctors do to evaluate your tears, like examining your tears themselves. Both the doctors and the technicians look at your tears. Do you have a normal amount present just on viewing? Are they clear? Is there any debris, stuff like mucous or clumps of white blood cells present?

Before we put anything into your eyes we will often use a special instrument called an osmometer to check your tear OSMOLARITY, how salty your tears are. This is a very new, fully FDA approved test to evaluate whether you have a normal amount of salt in your tears. Normal is below 300 and abnormal is above 308, with the 300-308 range being relatively non-diagnostic. This test is very helpful in determining whether or not you have the most common type of Dry Eye, especially when other signs are hard to see.

The doctor will then put a vegetable-base dye called FLUORESCEIN into your tears to evaluate their function. How long does it take before they "break up"? Tears should remain smooth over the front of the eye for at least 8-10 seconds. Does any part of the front of the eye become stained by the flourescein? Dye staining is a sign that your tears do not work well enough. Finally, tiny strips of filter paper may be placed just inside your eyelids for a test of your tear production called a SCHIRMER test. This helps us know the volume of tear production.

That's how we do it! Lots of work to make the diagnosis, but heck...you're worth it! Tune in for lots of information on how we TREAT Dry Eye, coming soon.

How Does The Eye Work?

How does the eye Work?

Over on our YouTube channel  we have a new series called "At the Dr. Whiteboard." Check it out! Pretty soon there'll be a video up that explains how our eyes work, and how it is that we actually see. Let's introduce that topic here and do a little review

Vision is kind of like filming a TV show. Our eyes act like the television camera, gathering images. The optic nerve works like the fiber optic cable that carries information from the television camera back to the computers in the production room. Those computers are very much like the back of our brain, the occipital cortex, where vision actually occurs.

So vision is actually a combination of three separate processes: focusing and capturing an image, changing that image into a series of electrical impulses that are then transmitted to the brain, and then processing those electrical impulses to re-create the image that we "see." Historically the majority of eye care has been dedicated to improving focusing, improving our ability to capture images. Cataract surgery, LASIK surgery, even something as simple as a pair of glasses allows us to create a sharp image.

Over time will talk a lot about these and other topics, as well as the exciting new vision processing programs like RevitalVision.

Introducing RevitalVision

As a leader in advanced techniques for vision improvement
 SKYVISION is a certified provider for:

THE WORLD’S ONLY PROVEN, NON-SURGICAL THERAPY TO IMPROVE VISION

Have you undergone cataract surgery, LASIK surgery or would simply like to reduce your dependency on reading glasses? RevitalVision may be right for you.

Train Your Brain to See Better

RevitalVision is designed to improve the communication between your eyes and your brain to help you see better. The program uses neural training to improve your vision. Just like learning to walk, riding a bicycle and learning to swim have long lasting effects, so does RevitalVision.

About the program:

§       20 training sessions completed at home on a computer

§       Each training session takes 20 minutes on average

§       Customized to your pace and visual ability

§       Professionally monitored by your
RevitalVision™ Personal Vision Specialist

Effectiveness

More than 3,000 customers and clinical trial participants that completed the program experienced improved eyesight and quality of life. Most customers notice results in as little as 10 sessions.These simple patterns, called Gabor patches, are optimally designed to stimulate neurons in the early stages of visual processing. They're called Gabor patches in honor of the Nobel-Prize winning physicist, Dennis Gabor, who provided the mathematical basis for this kind of filtering. Learn more about the technologyBased on science created by Nobel Prize Winners, RevitalVision is supported by more than two decades of scientific and clinical research.

On average, vision improves by two lines on an eye chart after completing RevitalVision. Benefits include:

§       See the medical presentations section for detailed results.

§       Individual results may vary.

§       Reading smaller print on a newspaper, menu, or computer screen

§       Reading better in low light conditions

§       Seeing objects better at night

§       Reducing or eliminating the need for reading glasses.

Safety
Extensively tested by reputable eye doctors and eye institutes in the U.S. and across the globe prior to being released for commercial use, the program is 100% natural and improves vision with:

• No additional surgery
• No glasses
• No drugs
• No known risks, side effects or complications

Learn more
To learn more, visit: www.revitalvision.com

_____________________________________________________________________________________________

“Headlights were less glary. Newsprint was crisper. When I sat down with a book before bed, I no longer had to hold the book at arm’s length to decipher words. And, when I went to my doctor for my final post-training exam, I could read the smallest letters on the eye chart: EDFCZP. I had gained a whole line on the eye chart! I’ve never been so happy to see anything in my life.”

Ginny Graves, Author
Vogue Magazine
October 2009